HEALTH CARE ADVISORY BOARD Meeting Summary January 11, 2016

HEALTH CARE ADVISORY BOARD
Meeting Summary
January 11, 2016
MEMBERS PRESENT
Marlene Blum, Chairman
Bill Finerfrock, Vice Chairman
Rose Chu, Vice Chairman
Ann Zuvekas
Tim Yarboro, MD
Francine Jupiter
Rosanne Rodilosso
Dr. Michael Trahos, DO
Ellyn Crawford
STAFF
Sherryn Craig
GUESTS
Jay Hicks, Senior Vice President, Artis Senior Living
Angelina Rotella, Project and Communications Coordinator, Artis Senior Living
G. Evan Prichard, Walsh, Colucci, Lubeley, & Walsh, PC
Michael Forehand, Inova Health System
Rosalyn Foroobar, Health Department
Arsenio DeGuzman, Health Department
John Silcox, Health Department
Call to Order
The meeting was called to order by Marlene Blum at 7:35 pm.
December 14, 2015 Meeting Summary
The meeting summary from December 14, 2015 was approved as submitted.
Resolution Honoring 25th Anniversary of the Community Health Care Network
The HCAB unanimously approved a resolution honoring the 25th Anniversary of the
Community Health Care Network (CHCN).
Public Hearing on Artis Senior Living, LLC’s Application SE-2015-MV-032
Jay Hicks, Senior Vice President, Artis Senior Living, presented the application (SE2015-MV-032) to build an assisted living facility at 8911 Ox Road in Lorton. The entire
facility will be dedicated to individuals with Alzheimer’s disease and related memoryHealth Care Advisory Board Meeting Summary 1/11/2016
Page 1
disorders. The 80-bed facility will be developed in two phases. The first phase will
include 64 beds across a two-story, approximately 36,000 square foot building. A
second phase will add 16 beds and approximately 4,000 square feet for a total of about
40,000 square feet.
The property is located between a church and a shopping center. Sunrise Assisted
Living originally had the property under contract, and was looking to develop a facility
with 100 beds. Artis Senior Living has had meetings with the South County Civic
Association, New Hope Housing, and seven homeowners who live directly behind the
building location.
Artis Senior Living is a local company with headquarters in McLean. Founded in 2012
by Bainum family members and leading senior care executives, the company has
experience owning and managing senior living residences. In 1998, the Bainum family
divested itself from ownership and control of Manor Care.
Artis Senior Living has managed facilities in Ohio, Alabama, and Pennsylvania for about
a year. With respect to the Pennsylvania facility, Rittenhouse Senior Living of Reading,
the facility was sold on November 15 and Artis Senior Living no longer manages the
property. Mr. Hicks stated that the Pennsylvania Department of Health’s inspection
report provided to the HCAB in their meeting packet cited issues that were outside the
scope of Artis’ management tenure.
Mr. Hicks also shared that Artis Senior Living has one property in Northern Virginia.
Effective January 1, Artis Senior Living assumed management of Great Falls Assisted
Living, which exclusively provides memory care services. Ms. Blum stated that when an
applicant does not have an operational history in Virginia, the HCAB reviews publicly
available information from states where a history is established. Given the timing of
Artis’ acquisition of Great Falls Assisted Living, the HCAB would not be able to use
documentation from the Department of Social Services to access the quality of care.
Mr. Hicks stated that Artis Senior Living is aware of the four percent development
condition and will participate by setting aside four percent of its units for Auxiliary Grant
recipients.
With the applicant’s presentation concluded and no community statements, the public
hearing was closed.
Health Care Advisory Board Meeting Summary 1/11/2016
Page 2
Mr. Hick’s clarified that Artis Senior Living owns and manages one facility in Mason,
Ohio, opened less than a year. Artis Senior Living manages two properties, the
aforementioned Great Falls Assisted Living and another property in Olney, Maryland.
Currently, the company has eight projects under construction. The Lorton location for
which Artis Senior Living is seeking a Special Exception will be owned and managed by
Artis.
Staff for the Lorton facility will be Artis employees. An Executive Director (ED) will
oversee nursing, activities, maintenance, and culinary operations. The ED will report to
Artis Senior Management in Tyson’s Corner.
Mr. Hicks stated that a cadre of committed caregivers will be hired, and they will be
certified as CNAs. Artis will augment staff certifications with internal trainings that
comply with state licensure requirements. A Registered Nurse (RN) and a Licensed
Practical Nurse (LPN) will be on duty during the first and second shifts with no roving
between facilities.
A LPN will be on duty during the third (overnight) shift. Using a 64-resident model, the
overnight shift will include a total of 6 staff: one caregiver per neighborhood, one
roving caregiver, and one LPN. Artis has systems in place that require caregivers to
make visual contact upon the hour with each resident. These contacts are charted in a
log. So while it may be possible for residents to access other rooms, existing protocols
should minimize its potential.
With respect to meal preparation, 2.7 FTE staff will prepare the meals. Caregivers will
help those who need assistance with feeding. The central kitchen will prepare meals
for all four wings/neighborhoods in the facility. The meals are bussed from the kitchen
and served restaurant style by CNAs to residents. Mr. Hicks acknowledged that some
modifications in meal preparation/serving may be required. Meals may need to be
served in residents’ rooms, but socialization will be encouraged.
While Artis’ materials do not indicate any overlap in staffing between shift changes, Mr.
Hick’s indicated that staff overlaps will occur.
HCAB members noted that working with dementia residents requires additional training.
Mr. Hicks said that Artis Senior Living meets the state requirements and will work to
exceed them. The Artis training model is a minimum of 12 but up to 24 hours of inservice and continuing education in addition to 8 hours of onboarding orientation. The
minimum training requirement, according to state regulations, is 12 hours.
Health Care Advisory Board Meeting Summary 1/11/2016
Page 3
With respect to architectural requirements, Artis Senior Living stated in its written
materials that per the International Building Code and ADA guidelines, eight accessible
resident rooms and bathrooms (10% of the total resident rooms) are planned. The
HCAB expressed concern and felt that given the population, most, if not all of the
rooms, should be accessible.
All units are planned for single occupancy. There are no kitchens. Bathrooms are
designed with showers. While visitors can sit comfortably in the rooms, permanent
double residency is not an option.
The facility will have elevators. The facility’s front door, as well as doors leading into
the residential neighborhoods, will be secured. An eight foot perimeter fence will
surround the outdoor courtyard. Walking paths are planned and residents are
encouraged to move freely, both inside and outside the facility.
Artis Senior Living will externally contract for physical therapy (PT) and occupational
therapy (OT) services. Residents will also have the opportunity to hire additional
care/private duty services should their needs require it. The HCAB asked for additional
clarification on what services would be provided and at what threshold residents may
no longer be served adequately by the facility. The HCAB asked if Artis staff have
procedures to assess residents who may require a skilled nursing facility.
Residents’ private physicians will have access to their patients, although Artis will also
have a contractual relationship with one or more physicians to visit residents if that’s
more convenient.
The HCAB expressed concerns about the market study that Artis Senior Living included
in its written materials, specifically how the applicant defined the market and what
providers are included in it, including the vacancy rates of other facilities. The HCAB
was also interested in the demographics of the target population Artis plans to serve.
Furthermore, given that compensation levels for ALF direct care staff are not
comparable with the cost of living in Fairfax County, HCAB members requested
additional information about Artis’ retention strategies and transportation/commuting
(i.e., lack of public transportation options).
Health Care Advisory Board Meeting Summary 1/11/2016
Page 4
Mr. Hicks explained that Artis is exploring two pricing methods – a monthly fee versus a
tiered approach. As additional research is gathered, they may offer a hybrid of these
models.
Medication will be dispensed by a licensed nurse or licensed medication technician.
Medicines will be locked and secured at all times, and where necessary, refrigerated at
the nursing station.
Artis Senior Living’s performance evaluation process includes a review six months after
the initial hire, followed annually thereafter. A performance plan can be put in place for
employees with poor reviews.
Francine Jupiter moved that the HCAB defer its recommendation on Artis Senior Living’s
request to build an assisted living facility until it receives a more detailed response, in
writing, to questions and concerns identified by HCAB members. Bill Finerfrock, Dr.
Trahos, and Ann Zuvekas all seconded. The motion carried.
Inova Health System 2016 Capital Improvement Plan
Marlene Blum shared that Mike Forehand will be leaving Inova and that the January
HCAB meeting will be his last. The HCAB thanked him for his service to the HCAB and
wished well in his new position as Vice President of Government Relations and Counsel
at the Northern Virginia Chamber of Commerce.
Mike Forehand presented Inova’s Capital Improvement Plan with update of the project
notification threshold. Using the TURNER Building Cost Index, the project notification
threshold has increased 1.6% because of increased private sector development and
investment as well as material price increases and is valued at $2,126,642 in 2015
dollars.
Ongoing capital improvement projects for Inova Fairfax Hospital (IFH) costing $2 million
or more include the expansion of the existing campus.
Women’s & Children’s Hospital: $431 million –The Women’s and Children’s
Hospital, adjacent to the South Patient Tower, is complete and under budget.
Patients will transition to the new hospital January 23-26. The 660,000 square
foot, ten-story building will house 192 private rooms for women’s services, 118
beds for pediatric services, a 108 bassinet NICU, eight operating rooms, six Csection rooms, and 33 labor and delivery rooms.
Health Care Advisory Board Meeting Summary 1/11/2016
Page 5
Existing Tower Building (ETB) – Renovation of the ETB to convert semiprivate
patient rooms to private ones is complete and occupied.
Green Garage: $35.6 million – The 1,250 space, eight-level free standing parking
garage that will service the new Women’s and Children’s hospital is complete and
open.
MRI Replacement – Installation of a new 3T MRI and improvements to the MRI
suite are complete.
Ongoing capital improvement projects costing $2 million or more include the Inova
Center for Personalized Health (ICPH). The Inova Center for Personalized Health will
provide translational research and individualized treatments to better understand,
predict, prevent, and eliminate cancer. The ICPH will house a diverse team of
providers, including holistic team researchers, clinicians, researchers, genetic
counselors, nutritionists, navigators, and wellness coaches.
To that end, the Inova Comprehensive Cancer and Research Institute (ICCRI) has been
renamed the Inova Dwight and Martha Schar Cancer Institute (ISCI) and relocated from
the Inova Fairfax Medical Campus to the Inova Center for Personalized Health (ICPH)
campus (formerly the Exxon-Mobil campus purchased by Inova in late 2015). ISCI will
house radiation, oncology, imaging, and women’s cancer services.
Drawings were submitted to the Department of Planning and Zoning for permitting
review. Construction and renovation are expected to begin March 2016 with occupancy
projected in the third quarter of 2018. The ISCI will be located in Tower 2, Building A.
A four story structure will be added behind the ISCI for a lead-lined vault to allow
radiology/oncology operations.
Ongoing capital improvement projects for Inova Mount Vernon Hospital (IMVH) costing
$2 million or more include:
Emergency Department (ED) –The new 35 bay, 20,000 square foot ED, adjacent
to the current ED location, is expected to improve patient throughput and meet
current code requirements. Target completion is scheduled for the fourth
quarter of 2016, after which the existing ED space will be repurposed.
Miscellaneous Infrastructure – Inova is making repairs and replacing the roof
with target completion scheduled for the second quarter of 2016.
Health Care Advisory Board Meeting Summary 1/11/2016
Page 6
Sterile Processing Department Renovation – The hospital’s Sterile Processing
Department Renovation is completed.
MRI Equipment – plans to replace and renovate the MRI Suite are scheduled for
completion in the second quarter of 2016.
Ongoing capital improvement projects for Inova Fair Oaks Hospital (IFOH) costing $2
million or more include:
Surgery Expansion – This two-story expansion, 15,500 square feet of new
construction will expand the surgery program by a net additional two operating
rooms, relocate two existing ORs, and provide supporting rooms (e.g., sterile
processing unit) and other staff areas. The steel structure is complete with
plumbing and electrical work to be completed by the second quarter of 2017.
Homeless Medical Respite Program
Michelle Milgrim, Director of Patient Care Services, presented on the Health Department
Homeless Medical Respite Program (MRP). The presentation began with the story of a
MRP client, Marcos.
The Fairfax County Medical Respite Program (MRP) was implemented in October 2006.
Respite care was defined as “recuperative or convalescent services needed by homeless
persons with medical problems – in essence providing sick or injured homeless persons
a respite from the dangers of living on the street.
The Health Care Advisory Board was tasked by the Board of Supervisors to examine the
medically frail homeless population and recommend alternatives for meeting their
medical needs. While the Health Department and the Department of Family Services
(DFS) jointly administer this program, DFS assumes lead responsibility for the MRP.
The Embry Rucker Community Shelter in Reston houses the program: there are five
beds - four beds are dedicated to male patients and one for females. To serve as many
acutely vulnerable adults as possible, care is limited to 30 days.
Eighty percent of the individuals screened and admitted into the program are men;
twenty percent are women. The average age of MRP clients is 50 years-old. Compared
to FY 2014, clients are older at MRP enrollment. Clients are racially and ethnically
diverse (White = 32, Black = 24, and Asian =1), although the majority of individuals
admitted in FY 2015 were non-Hispanic whites (Hispanic = 9/Non-Hispanic = 48). With
Health Care Advisory Board Meeting Summary 1/11/2016
Page 7
few exceptions, MRP staff are admitting only those clients who can be stabilized and
treated within the 30 day window. At 27 days, clients’ average length of stay is below
the program target.
There were 57 admissions for 50 unduplicated clients in FY 2015, an increase of 12
percent from FY 2014. Five clients were admitted twice while one was admitted three
times. MRP had 218 referrals to the program in FY 15. Despite the increase in client
enrollment, some clients do not meet the program’s eligibility requirements. Some
clients were ineligible because they were not Fairfax County residents (n=21); they
were not homeless (n=14); or they did not require respite care or their level of care
exceeded the program’s length of stay requirement (30 days) (n=67). Others refused
to enter the program because they did not want to relocate to Reston or because they
did not want to go into a shelter.
A small percentage (4%) of clients were waitlisted, having qualified for the program but
having no bed available. More often, clients were waitlisted because something
prevented them from entering the program (e.g., surgery postponed, stayed in the
hospital, or were banned from the shelter) or an alternative placement was identified.
In the latter case, clients decided to stay with friends or family, went to a nursing home
or sought placement at a regular shelter. In some cases, while clients were
transitioning between an inpatient hospital bed and a MRP placement, they would leave
the hospital against medical advice (AMA or hospital case managers did not follow up).
Patients presented with complex pathologies, often suffering from more than one
problem. But clients made remarkable progress during their stay in the MRP. With the
exception of a few clients, everyone experienced improvement in one or more of their
conditions: 77% of clients’ conditions improved; 20% of clients’ conditions remained
stable; and 3% of clients’ conditions did not improve.
Key to helping patients recover and maintain their overall health is access to routine
medical care, vis-à-vis a medical home. Upon exit from the program, the majority
(n=54) of our clients were enrolled in a medical home with access to primary care.
Upon discharge from the MRP, nearly one-half of the clients continue to stay in an
emergency shelter. The remaining clients are precariously housed or unsheltered.
Individuals discharged receive a continuum of care, including medical care and case
management.
Health Care Advisory Board Meeting Summary 1/11/2016
Page 8
The Medical Respite Program continues to serve medically fragile clients with acute
health care needs, but the need for chronic care and skilled nursing care services
continues. Approximately 30% of all patients who applied had chronic or high-level
care needs that excluded them from entry into MRP.
MRP post-discharge data also suggests a continued need for temporary and permanent
housing. Without a safe place to live, many clients will continue to cycle in and out of
the county’s safety net services. The Health Department and the Department of Family
Services look forward to working with its partners to end homelessness, while
continuing to provide a safety net for the medically vulnerable still without a home.
The Fairfax County 50+ Action Plan 2014 includes an initiative to create emergency
housing for older homeless adults and those at risk of becoming homeless. Older adults
who are homeless are likely to have health conditions that worsen without safe
housing. Other communities across the country offer emergency shelter programs
targeting older adults.
The ERC currently house families with children, single men and women and is providing
day and evening drop in services, and a no turn away winter overflow which makes the
design and management of these cases challenging. Space limitations, outdated
bathroom and laundry facilities and frequent out of service handicap entrance doors
add to the limitations.
Nursing care during MRC hours ensures that medical needs are met, however during
the evening and overnight and weekend hours, shelter staff need to respond to a
clients needs.
Once a MRP client leaves the program and enters the regular shelter program, there is
an increased burden on case managers providing support and triage for rapid rehousing.
These issues are no different than the issues identified at the onset of the program,
however this may be the time to bring together a planning group to look at the existing
program with new eyes – now that Embry Rucker and Bailey’s Shelter are being
renovated and potentially expanded.
Health Care Advisory Board Meeting Summary 1/11/2016
Page 9
Discussion of George Mason University’s Center for Applied Proteomics and
Molecular Medicine
At the conclusion of the December 14 HCAB meeting, the HCAB agreed to send a memo
to the Board of Supervisors informing them of George Mason University’s (GMU) Center
for Applied Proteomics and Molecular Medicine’s (CAPMM) current and future research
initiatives. Subsequent to the HCAB’s meeting, Governor Terry McAullife announced a
strategic partnership between Inova and GMU to conduct translational research and
share resources. As a result, the memo was revised to include information on this
collaboration.
Upon discussion, it was suggested that the Aspiring Scientists Summer Internship
Program be qualified to include underserved Fairfax County Public Schools (FCPS)
students.
Ann Zuvekas moved that the HCAB send the revised memo to the BOS. Bill Finerfrock
seconded. The motion passed unanimously.
Other Business
The Health Department is monitoring the spate of legislation around Certificate of Public
Need (COPN) process.
The 2016 Lines of Business schedule has been posted. The Health Department is
scheduled for February 5 at 2:30 pm.
Sherryn Craig will send a list of potential meeting dates for March.
There being no further business, the meeting adjourned at 9:58 pm.
Health Care Advisory Board Meeting Summary 1/11/2016
Page 10